The number of electronic cardiac devices, including pacemakers and cardioverter-defibrillators, being implanted each year is increasing. As a result, there has been a 210% increase in the incidence of device infection between 1993 and 2008 in the United States. Cardiac device infective endocarditis (CDIE) is significant in that it is associated with a higher mortality rate than device infection without endocarditis.
Athan et al. examined prospective data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), collected from 61 centers in 28 countries over a six year period. All patients were hospitalised adults with definite endocarditis as defined by the modified Duke endocarditis criteria. The authors examined in-hospital and 1-year mortality.
CDIE was diagnosed in 6.4% of patients with definite infective endocarditis. CDIE generally occurred in older patients (median age, 71.2 years), was caused by staphylococci (66.6% of patients), and was associated with contact with health care services (45.8%). 37.3% of patients also had co-existing valve involvement (especially the tricuspid valve). In-hospital and one-year mortality rates were 14.7% and 23.2%, respectively. Removal of the device was associated with an increased chance of survival at one year (hazard ratio 0.42 when compared to patients who did not undergo device removal).
Conclusion:
Patients with cardiac device infective endocarditis have high rates of mortality and concomitant valve infection. Early device removal is indicated to improve survival at one year.
- Athan E, Chu VH, Tattevin P et al. Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices. JAMA 2012;307:1727-1735.